Anticoagulation Reversal

No patient weight set. Open Pediatric Weight, Age, Height, or Length Tape to enable dose calculations.
Disclaimer
• Reversal decisions should weigh bleeding risk vs. risk of thrombosis. • Confirm the agent, last dose timing, indication for anticoagulation, and current labs (PT/INR, aPTT, anti-Xa, platelet count). • Consult hematology / pharmacy for complex cases.
Reversal agents by anticoagulant
AnticoagulantReversal agentDose
Warfarin (life-threatening bleed)4-Factor () + INR 2-<4: 25 units/kg • INR 4-6: 35 units/kg • INR >6: 50 units/kg (max 5000 units) + Vit K 10 mg IV
Warfarin (non-emergent) ()1-10 mg PO/IV depending on INR and bleeding
Dabigatran (Pradaxa) ()5 g IV (two 2.5 g vials)
Apixaban / Rivaroxaban alfa () or : low/high dose per last dose & timing • : 50 units/kg (off-label)
Unfractionated Heparin sulfate1 mg per 100 units given in last 2-3 hr (max 50 mg/dose)
(Enoxaparin) sulfate1 mg per 1 mg if <8 hr; 0.5 mg per 1 mg if 8-12 hr
Antiplatelet (/)Platelet transfusion (selected cases)1 apheresis unit; consider DDAVP 0.3 mcg/kg IV
/ ThrombolyticCryoprecipitate ± 10 units cryoprecipitate; 1 g IV over 10 min
Adjuncts
• Activated charcoal if recent (<2 hr) ingestion of oral anticoagulant. • 1 g IV for traumatic / mucosal bleeding. • Consider massive transfusion protocol for hemorrhagic shock.